Women for World Health: Saving the World, One Patient at a Time

by Shyla Nambiar

Women for World Health president Denise Cucurny with patients and family in the Andes, 2007

The nun brought the little orphan girl to the mission site in Ecuador. She had a cleft palate and needed surgery.

After the successful surgery, the little girl returned three or four days later. She brought a picture of her class at school, with her in it. It was the only thing she had of herself, and she wanted the doctors to remember her by it.

On the back, the nun had written a note for her. "Dear Women for World Health," it said. "I want to thank you for helping me. You have made me very happy. I will always remember you, and this is a photo so that you can always remember me."

Medical director Dr. Amy Wandel with Ana Arteaga and her father in the recovery room after cleft palate surgery. Azogues, Ecuador, 2003.

Thanks to Women for World Health (W4WH), this little girl -- and many children like her, as well as adults -- can lead more productive lives. Founded in June 2006, W4WH is the brainchild of Denise Cucurny, an anthropology professor, and Dr. Amy Wandel, a plastic surgeon. The two met on a medical mission in 2000 and had an immediate rapport. Ms. Cucurny and Dr. Wandel met periodically, and during one of their meetings, Ms. Cucurny confided that she wanted to create a nonprofit organization that could be responsive to a community's medical needs, expanded beyond plastic surgery. Dr. Wandel wanted to be involved. Today, Ms. Cucurny serves as president of W4WH, and Dr. Wandel is the medical director.

While the organization was founded by and is directed by women, it does not focus solely on women's issues. W4WH, in partnership with other organizations, sponsors two or three medical missions a year in various parts of the world, including Africa, Asia, and Latin America.

The medical teams include both male and female medical practitioners, specializing in ophthalmology, dentistry, plastic surgery, pediatrics and other areas needed in the communities. The missions include between 12 to 16 personnel. In addition to doctors, the team brings its own medicine, equipment, and supplies. The mission is usually accomplished in one week.

Just organizing one of the missions is a huge undertaking. Ms. Cucurny does site visits to places where W4WH has been invited in order to determine the needs. She evaluates the facilities and the patient base and meets with the hospital director or coordinator of medical services. She also determines whether there are enough patients to warrant a mission.

Putting together a mission involves calling volunteers from W4WH's database of doctors, nurses, and nonmedical personnel. The latter group organizes the transport of patients, coordination of the team, and translation. Supplies and equipment must be gathered, and all the paperwork and details coordinated. Preparation for a mission can take four months.

As medical director, Dr. Wandel reviews applications and interviews volunteers, making sure they understand what volunteering with W4WH involves. She develops safety protocols for the medical team and guidelines for surgical practices. She also performs plastic surgery at the mission sites.

Sisters Ana (21), Merida (25), and Dexi (23) Arteaga, all born with a cleft palate, on the ward after surgery. Azogues, Ecuador, 2003.

W4WH works in countries such as Ecuador, South Africa, Laos, and Guatemala and in regions such as the Himalayas and the Andes. In these areas, the medical teams see a wide variety of conditions: eye diseases and cataracts, tumors, ear and dental infections, burns, and injuries due to electrocution. The need for tendon reattachment is surprisingly common. In developing countries, machetes are used extensively, and there are many hand injuries involving cut tendons. Reconstructive surgery patients arrive with burn scars, congenital hand deformities, and foot deformities. The medical teams often do not know what they will be treating until the patients arrive. "You never know what will walk through the door," Ms. Cucurny said.

Dental infections are a major problem. Modern dental hygiene is not common in poorer countries, and diseased teeth and gums are the norm. Periodontitis is common, and extensively damaged or diseased teeth must be pulled. Ms. Cucurny recounted the story of a woman in Laos who was in a lot of pain and had to have 18 teeth pulled. "She was so grateful that she bought [the dentist] the best thing she could possibly come up with, which was dried rat meat. . . . This was the best thing she had."

John Huerta, 9 months old, with his mother, has a bilateral cleft lip. Azogues, Ecuador.

According to both Ms. Cucurny and Dr. Wandel, the most gratifying part of the missions is their work with children.

"Children are wonderful," Dr. Wandel said. "They want to get better. They want to be normal. They are very honest when they are in pain. . . . For the most part, children are really fun to work with." For reconstructive surgery, Ms. Cucurny stated that "kids are our priority."

The medical teams see a lot of burn injuries in their work. Ms. Cucurny said, "In the third world, they use fire for cooking, heating, and light. . . so we see a lot of burn injuries, accidents. . . pajamas caught on fire. . . cooking accidents where kids have fallen into a vat of boiling water."

Ms. Cucurny, who worked with the organization Plasticos Foundation, which does reconstructive surgery, related the case of Homero. He and his family walked four days through the Amazon jungle to reach a bus that would take them to the Plasticos clinic. Homero had a burn so severe that his hand was fused to his forearm. After surgical treatment he was transformed, and he could once more lead the life of a normal little boy.

An important part of W4WH's focus on children is reconstructive surgery, particularly cleft lip and cleft palate surgery. For the children, surgery does not merely treat a physical problem; rather, it erases a social stigma.

According to Dr. Wandel, "They're really alienated from, not only their village, but society in general, because they're considered to have been given a curse because they were born with a cleft lip or palate. You fix them and they can rejoin society and their family can rejoin the village society. It's a remarkable experience."

Ms. Cucurny concurs."[Dr. Wandel will] do a surgery, it might take her 30, 40 minutes, and it totally changes the life of that child and their family."

For their work, the medical teams receive the gratitude of their patients. Ms. Cucurny said, "More times than I could possibly ever count we hear, 'You have been sent by God.'"

Dr. Wandel concurs; she sees the people as "overwhelmingly grateful." Local medical personnel assist in the operating room or are trained by the doctors on the mission so they can take care of the patients afterward.

Education plays another important part in W4WH's mission. In Guatemala, the focus is on preventive medicine, nutrition, and hygiene. The local population is often unfamiliar with the concept of germs, so education is essential. Nutritional education involves tailoring the concepts of a well-balanced diet to what is available in the area.

W4WH works around the world, and is now considering bringing its mission to America. Directed towards Americans who have no health insurance, plans are in discussion for a facility to provide care to the uninsured. The organization is in talks with a group of nurse-practitioners in practically every specialty to realize this plan, which includes the payment of a flat fee per year for any kind of medical services needed. The city where W4WH is interested in establishing the clinic is considering donating office space. Ms. Cucurny's goal for 2009 is to make "significant inroads" into this project.

Other plans include more missions, including working in Calcutta on reconstructive surgery, ob-gyn, and pediatric care for sex workers; return trips to the Himalayas and Guatemala; and a mission to Ecuador to train surgeons in the treatment of burn contractions. Another goal is returning to previously visited locations to do follow-up care and maintain a relationship with the community.

W4WH's mission statement includes the declaration, "It's time to give back." Both founders practice this philosophy. Dr. Wandel asserted, "Plastic surgeons, specifically -- we have the ability to change someone's life with a surgical procedure. . . . I believe that because I was given that talent and the opportunity to practice it, that I should give that to people who can't otherwise."

Ms. Cucurny's goal is similarly ambitious. "I want to save the world, one patient at a time."

About Angels in Medicine

Angels in Medicine is a volunteer site dedicated to the humanitarians, heroes, angels, and bodhisattvas of medicine. The site features physicians, nurses, physician assistants and other healthcare workers and volunteers who reach people without the resources or opportunities for quality care, such as teens, the poor, the incarcerated, the elderly, or those living in poor or war-torn regions. Read their stories at www.medangel.org.